Biomedical subjects
Publications and source records attributed to A Ayhan.
Maternal mortality was found to be 140 deaths per 100,000 live births in Hacettepe University Hospital. Infection, hemorrhage and cardiac disease were still the leading causes of maternal deaths. It is possible to reduce the maternal mortality due to these largely preventable causes if standards of care and treatment are raised to a higher level throughout the country.
This study includes 278 patients with Stages 1 and 2 cervical cancer subjected to type 3 hysterectomy and lymphadenectomy. The incidence of lymph node metastasis and effect of paraaortic lymphadenectomy on 5-year survival were evaluated. The overall incidences of pelvic and paraaortic lymph node involvement were 24.1% and 8.0%, respectively. The overall 5-year survival rate was 83.8%. The 5-year survival of patients subjected to both pelvic and paraaortic lymphadenectomy was found to be 84.6%; the figure was 80.9% for patients subjected to only pelvic lymphadenectomy. No statistical difference in survival was found between patients with and without paraaortic lymphadenectomy.
The plasma levels of beta-thromboglobulin (BTG) and platelet factor 4 (PF-4) were measured in patients during the normal obstetric period and in preeclampsia. A significant increase was observed in the two proteins with respect to the nonpregnant control group. Both proteins increased significantly with preeclampsia and a further increment was observed with the severity of preeclampsia though no significant difference in PF-4 levels was encountered between pregnant and mildly preeclamptic women. There was no correlation between BTG, PF-4 and thrombocyte counts.
An endogenous digoxin-like substance (DLIS) that may be related to preterm labor has been studied. Using a commercially available radioimmunoassay kit. DLIS levels were determined in 110 women, of whom 33 were in preterm labor, 27 were in labor at term, 26 had normally ongoing pregnancies before term and were not in labor, and finally 24 were at term but not in labor. Mean DLIS levels of women in preterm labor was found to be significantly high (greater than 0.2 ng/ml, p less than 0.05). Whether this finding points to a causative role for DLIS in preterm labor remains to be further investigated.
Forty-nine women who had received chemotherapy for gestational trophoblastic disease subsequently became pregnant a total of 65 times. Of these 65 pregnancies, 42 (64.7%) terminated in term births, 4 (6.1%) in premature births, 1 (1.5%) in stillbirth, 8 (2.3%) in spontaneous abortion and 7 (10.8%) in elective abortion, while 3 patients (4.6%) had repeat molar pregnancies. No congenital malformations or obstetric complications were observed. Treatment of gestational trophoblastic disease with chemotherapy is compatible with the preservation of fertility and is not associated with any increase in congenital fetal malformations.
Twenty-three patients diagnosed as lichen sclerosus with colposcopic directed biopsy were given topical testosterone as a first line therapy. The overall remission rate was found to be 87.7%; 8.7% of the patients experienced undesirable androgenic side effects. Of the three patients who did not respond satisfactorily to testosterone treatment, two had alcohol injection to the vulva and one had vulvar denervation.
Data of 20,291 deliveries are presented; 6.85% (1389) of the patients were 19 years old or under and 6.24% (1276) were 35 or over; 7352 women had one child (primipara) and 1475 had five or more. Cephalic presentation constituted 94.2% of deliveries. The total induction rate was 9%. The incidence of prematurity and post-term gestation was 13 and 7.2%, respectively. Prolonged labor was encountered in 4% of the patients. Anesthesia was employed in 65.8% of all deliveries. Total and primary cesarean section rates were 9.77 and 7%, respectively. The incidence of fetal mortality was 2.55% and congenital anomalies were seen in 1.53% of the infants. The birth weight was under 2499 g in 9.5% of the newborns. Pregnancy complications of different magnitude were encountered in 23.7% of the cases. Uterine rupture and inversion rates were 0.12% and 0.005% respectively. The maternal mortality rate was found to be 64.06 per 100,000 deliveries.
The histological specimens of 73 patients who presented with undescended testes after puberty were re-evaluated. None of the specimens revealed carcinoma in situ but in the specimens of 5 patients severe atypia was detected. None of the patients, including 5 with severe atypia, has shown any evidence of invasive testicular tumour during follow-up.
The histological effects of unilateral incarcerated inguinal hernia on the ipsilateral and contralateral testes were examined in adult rats. Three groups were established. In the first group the left testis and caecum were exposed and replaced. In group 2 a left-sided incarcerated inguinal hernia was created with bilateral orchiectomy 24 h later. In group 3 a left-sided incarcerated inguinal hernia was created with reduction after 24 h. The testes of animals in groups 1 and 3 were removed after 15 days. The mean seminiferous tubular diameter (MSTD) and mean testicular biopsy score (MTBS) were determined for ipsilateral and contralateral testes in each of the 3 groups. A decreased MSTD and depressed MTBS, were pronounced in the ipsilateral testes, were found in the testes of group 3 animals. While unilateral incarcerated inguinal hernias caused more pronounced histological changes in the ipsilateral testes, they also affected the contralateral testes, but a time interval was required for the changes to become manifest.
Of 86 patients diagnosed as having vulvar dystrophy in a 10-year period 56 (65.1%) had hyperplastic dystrophy, 23 (26.7%) had lichen sclerosus and 7 (26.7%) had mixed vulvar dystrophy. The diagnoses were made by colposcopic or toluidine blue directed biopsies. Fluorinated corticosteroids were given to patients with hyperplastic dystrophy with a response rate of 90.1%. Patients with lichen sclerosus received topical testosterone propionate and the response rate was 87.7%. Topical fluorinated corticosteroids followed by testosterone propionate was given to patients with mixed dystrophy and 85.8% of the patients responded. Surgical therapy was reserved for patients with failed medical treatment.
The incidences of pelvic and paraaortic lymph node metastases in 106 patients with clinical Stage 1 endometrium cancer are presented. All patients were primarily surgically staged and treatment consisted of peritoneal cytology assessment, type II radical hysterectomy, bilateral salpingooophorectomy, pelvic and paraaortic total lymphadenectomy. Pelvic lymph node metastases were present in 15.1% and paraaortic lymph node metastases in 8.5% of the patients. Multiple prognostic factors were evaluated in respect to nodal status. This study adds credence to primary surgical staging with total pelvic and paraaortic lymphadenectomy regardless of presence or absence of the various risk factors.
This study includes 22 cases of Stage I cervical adenocarcinoma. The lymph node metastases and 5-year survival according to the size of lesion and grade of tumour were evaluated. The overall pelvic and para-aortic lymph node metastases were found to be 31.8% and 0% respectively. Metastases in the pelvic lymph nodes were found in 16.6% of patients with lesions less than 2 cm and 50.0% of patients with lesions 2 cm or greater in size. Pelvic lymph node metastases were found to be 0% for Grade 1, 25% for Grade 2 and 46% for Grade 3 tumours. The overall 5-year survival was 68.2%. This figure varied from 60% to 75% according to the size of lesion and from 61.5% to 100% according to the grade of tumour.
Twenty-one patients with squamous cell carcinoma of the vulva who were subjected to radical vulvectomy and inguinal-pelvic lymphadenectomy were studied. The overall mortality rate was 24%. Operative- and tumor-related mortalities were 9.5% and 14.2%, respectively. Recurrence was seen in 5 patients. The most common complication was wound infection and breakdown.
One hundred and fifty-six patients with cervical intraepithelial neoplasia (CIN) were treated with CO2 laser and followed for 2 1/2 to 6 years. There were 19 recurrences, of which 14 occurred in patients treated with a power density of less than 1000 W/cm2 to a depth of 6 mm. All of the recurrences were subjected to a second laser treatment. Overall failure rate was 4.5%. The incidence of acute bleeding during, and late bleeding 6 to 14 days following treatment, were 8 and 4%, respectively. Late bleeding occurred in patients who were treated with 800 to 1000 W/cm2 power density and to a 3 to 10 mm depth of destruction. Complications were directly and failures were inversely proportional to the power density and depth of destruction. Following therapy, the transformation zone was adequately seen in the majority of the patients.
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